Localized Kidney Cancer Research Articles

Real-life use of diagnostic biopsies before treatment of kidney cancer: results from a Norwegian population-based study

Objective: Interest in renal mass biopsies (RMBs) has increased in recent years. However, most publications are low-volume and/or single-center studies, so their generalizability is questionable. The aim of this study was to describe population-based, real-life use of diagnostic RMBs for localized and advanced kidney cancer (KC).Materials and methods: All KC patients diagnosed during 2008–2013 extracted from the database at the Cancer Registry of Norway were included. Relationships with outcome were analyzed using multivariate logistic regression and competing risks analyses.Results: Of patients treated radically for localized KC, a pretreatment RMB was used in 8.4%. For similar patients treated by observation only, the rate increased from 29.3% to 60.7% during the study period. Tumor size ≤4 cm, another malignancy, multiple tumors, old age (≥ 80 years) and second study half were independent RMB predictors. Competing risks analysis showed that among radically treated patients with localized KC, those who had undergone an RMB had a higher risk of dying of other diseases. In patients with advanced KC, biopsy was used in 54.5%, and is increasing. Study limitations include a lack of data on benign tumors, comorbidity and performance status.Conclusions: For localized KC, the use of RMBs in Norway is in line with current guidelines. Because real-world data on RMB use are scarce, this study is useful for benchmarking in future studies. Furthermore, the study shows that fewer patients with advanced KC are treated without histopathological verification, and biopsies seem to have an increasing role in tailoring treatment.

Platelet to white blood cell ratio predicts 30-day postoperative infectious complications in patients undergoing radical nephrectomy for renal malignancy.

We sought to examine the relationship between preoperative platelet to white blood cell ratio (PLT/WBC), a hematological marker of the systemic inflammatory response, and postoperative infectious complications following radical nephrectomy for localized renal cell carcinoma. We performed a retrospective cohort study of patients treated with radical nephrectomy for localized kidney cancer between January 1, 2005 and December 31, 2014 (n=6235) using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Univariate and multivariate analyses were used to assess the association between PLT/WBC ratio and 30-day infectious complications, including surgical site infection, urinary tract infection (UTI), pneumonia, and sepsis. Secondarily, we examined major complications and bleeding requiring transfusion. A lower PLT/WBC ratio was associated with an increased risk of sepsis, pneumonia, and UTI rates (p<0.05 for all). Furthermore, there was a significant trend of decreasing rates of sepsis and pneumonia with increasing PLT/WBC ratio across quintiles (p<0.05 for all). On multivariate analysis, patients with the lowest PLT/WBC ratios (Quintile 1) had a two-fold risk of having a postoperative infectious complication compared to patients in the highest quintile (odds ratio [OR] 2.01; 95% confidence interval [CI] 1.42-2.86; p<0.0001). Patients in Quintile 5 had a higher risk of requiring blood transfusion than those in Quintiles 2-4 (p<0.05 for all). The PLT/WBC ratio represents a widely available and novel index to predict risk of infectious and bleeding complications in patients undergoing radical nephrectomy. External validation is required and the biological underpinning of this phenomenon requires further study.

Surgical resection of locally recurrent renal cell carcinoma after nephrectomy: Oncological outcome and predictors of survival

ObjectiveTo describe the course of disease of patients surgically treated for locally recurrent renal cell carcinoma (LRRCC) after nephrectomy and to identify potential predictive factors for long-term survival. Patients and methodsWe, retrospectively, identified 54 patients who underwent surgical resection of LRRCC after open nephrectomy for localized kidney cancer. The median age at time of surgery for LRRCC was 65 years. Survival rates were determined with the Kaplan-Meier method. Mantel-Haenszel hazard ratios were calculated. Comparisons were made with the log-rank test. Cox proportional hazard models were used to analyze combined effects of variables. ResultsMedian time to local recurrence after nephrectomy was 36 months (5–242 months). Median follow-up after surgery for LRRCC was 39 months. At time of analysis 18 patients (33%) were alive without any evidence of disease, 8 patients (15%) were alive with disease, 20 patients (37%) died of renal cell carcinoma, and 8 patients (15%) died of other causes. A 5-year overall survival (OS) was 60% (95% CI: 0.44–0.73) and 10-year OS was 32% (95% CI: 0.15–0.51). The median survival after surgery for LRRCC was 79 months. In univariate analysis OS differed significantly by the time period between primary surgery and occurrence of LRRCC (<2 years vs. ≥2 years: 10-year OS rate 31% (95% CI: 10.2–55.0) vs. 45% (95% CI: 21.5–65.8; hazard ratio = 0.26; P = 0.0034). In multivariate analysis sarcomatoid features in the primary nephrectomy specimen, positive surgical margins of the LRRCC specimen and a Charlson score of ≥2 were associated with a significantly worse prognosis in this cohort. ConclusionIn patients with a disease-free interval of more than 2 years after surgery for the primary tumor, surgical removal of LRRCC may achieve long-term survival in most patients. In those with a shorter disease-free interval, long-term survival is unlikely.

Postoperative delirium incidence and oxidative stress in laparoscopic surgery

Postoperative delirium is a common complication of all types of surgery, especially in elderly patients (2). Overproduction of free oxygen radicals and decrease of organism defense mechanisms is believed to be involved in multiorgan failure, especially in the brain (4). It is important to determinate the susceptibility, incidence and preventive measures for postoperative delirium (8). Our objective was to identify an oxidative stress indicator that predicts the appearance of postoperative delirium in patients that undergoes laparoscopic renal or gynecological surgery for malignant diseases and the possible correlations between certain anesthetic drugs and postoperative delirium occurrence. This study included 29 patients that were treated for localized kidney or uterine cancer by trans peritoneal laparoscopic radical surgery procedures (nephrectomy or hysterectomy) between 2014 and 2016. They were randomized in two groups: the sevoflurane group (n=14 patients) and propofol group (n=15 patients). Blood samples were collected before anesthesia induction, at the end of surgery and at 24 h after surgery and the levels of malondialdehyde (MDA) and superoxide dismutase (SOD) were measured. Postoperative delirium was assessed using Confusion Assessment Method for the ICU (CAM-ICU). All patients with delirium from both groups developed the condition on the first postoperative day. In the sevoflurane group, postoperative delirium has observed in 6/14 patients (42%) and in the propofol group, 5/15 patients (33%) have developed the same postoperative syndrome. There was a significant increase of malondialdehyde levels in the delirium group compared to the non-delirium group in patients, sevoflurane and propofol, at the end of surgery. (p&lt;0.05) There were statistical difference between delirium group and non-delirium group in both sevoflurane and propofol patients, regarding superoxide dismutase levels before anesthesia induction (p&lt;0.05). Postoperative delirium incidence can be predicted by preoperative superoxide dismutase levels assessment in patients that undergoes laparoscopic urologic or gynecological surgery for malignant diseases.

Adjuvant Therapy for High Risk Localized Kidney Cancer: Emerging Evidence and Future Clinical Trials.

We reviewed the literature on adjuvant therapies for patients with high risk localized kidney cancer following surgical resection. In this analysis we merge 2 recently published prospective trials with conflicting results within the context of their respective designs. In addition, we spotlight upcoming trials that use novel immunotherapy based checkpoint inhibitors and have the potential to establish a new standard of care. We searched PubMed® for English language articles published through January 2017 using the keywords "renal cell carcinoma," "kidney cancer," "immunotherapy," "targeted therapy" and "adjuvant therapy." ClinicalTrials.gov was queried for ongoing studies. Relevant data recently presented at major urology and medical oncology meetings are also included. Adjuvant therapies for high risk localized kidney cancer can be grouped into the categories of 1) traditional immunotherapy, 2) inhibitors of the vascular endothelial growth factor and mTOR (mammalian target of rapamycin) pathways, 3) vaccines and antibody dependent cytotoxic agents, and 4) immune checkpoint inhibitors. Several trials of traditional immunotherapy, such as interferon-α and high dose interleukin-2, failed to demonstrate benefit as adjuvant treatment and were associated with significant adverse events. Vascular endothelial growth factor and mTOR inhibitors have less severe toxicity in metastatic disease and, therefore, are natural considerations for adjuvant trials. However, current data are conflicting. The ASSURE (Sunitinib Malate or Sorafenib Tosylate in Treating Patients with Kidney Cancer that was Removed by Surgery, NCT00326898) trial found no recurrence-free survival benefit of sorafenib or sunitinib over placebo, while S-TRAC (Clinical Trial Comparing Efficacy and Safety of Sunitinib versus Placebo for the Treatment of Patients at High Risk of Recurrent Renal Cell Cancer, NCT00375674) revealed that 1 year of sunitinib improved recurrence-free survival by 1.2 years. Vaccine based treatments and antibody dependent cytotoxic agents have had mixed results. New trials evaluating immune checkpoint inhibitors are planned, given the impressive efficacy and tolerability as second line agents in metastatic disease. Future adjuvant trials are likely to be guided by molecular signatures to treat patients most likely to benefit. Based on the available data, there appears to be no role for traditional immunotherapy as adjuvant treatment in patients with high risk localized kidney cancer following surgical resection. S-TRAC provides evidence that 1 year of adjuvant sunitinib in patients with higher risk locoregional disease increases the median time to recurrence. However, the data on overall survival are immature and adverse effects are common. Results from trials investigating immune checkpoint inhibitors are highly anticipated.

PD73-08 THE IMPACT OF INTRA VS. POST-OPERATIVE BLOOD TRANSFUSION ON CANCER RECURRENCE AND SURVIVAL FOLLOWING NEPHRECTOMY FOR RENAL CELL CARCINOMA

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy VII1 Apr 2017PD73-08 THE IMPACT OF INTRA VS. POST-OPERATIVE BLOOD TRANSFUSION ON CANCER RECURRENCE AND SURVIVAL FOLLOWING NEPHRECTOMY FOR RENAL CELL CARCINOMA Yasmin Abu-Ghanem, Zohar Dotan, Issac Kaver, Dorit Zilberman, and Jacob Ramon Yasmin Abu-GhanemYasmin Abu-Ghanem More articles by this author , Zohar DotanZohar Dotan More articles by this author , Issac KaverIssac Kaver More articles by this author , Dorit ZilbermanDorit Zilberman More articles by this author , and Jacob RamonJacob Ramon More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3201AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The effects of perioperative blood transfusion (PBT) on morbidity, mortality following cancer surgery have previously been demonstrated in several malignancies including renal cell carcinoma (RCC). However, the significance of transfusion timing is still unclear. The purpose of this study is to evaluate whether intraoperative BT (InBT) differ from postoperative BT (PoBT) in regards to oncological outcomes in patients treated with nephrectomy for RCC. METHODS Study included 1159 patients with RCC who underwent radical (RN) or partial nephrectomy (PN) between 1988 and 2013. PBT was defined as receipt of packed red blood cells either during surgery or during the postsurgical hospitalization. Univariate and multivariate models were used to evaluate the association of BT with cancer-specific survival (CSS), disease-free survival (DFS) and overall survival (OS). RESULTS Of 1159 patients undergoing nephrectomy, 198 patients (17.1%) received a PBT. Patients were next divided into 3 groups; no PBT, InBT alone (n=117) and PoBT alone (n=60). Twenty one patients of the PBT group (10.6%) received both intra and post-operative transfusion. Given the small number of patients, this sub-group was excluded. On multivariate analyses, receipt of InBT was associated with significantly increased risk of local disease recurrence (HR: 2.3; P=0.025), metastatic progression (HR: 2.2; P=0.006), cancer- specific mortality (HR: 2.95; P=0.009) and all-cause mortality (HR: 2.05; P=0.007); while receipt of a PoBT did not independently bear an increased risk of local recurrence (p = 0.1), metastatic progression (P=0.095) or kidney cancer death (P=0.53), yet did significantly increase the risk of overall mortality (HR: 2.6; P=0.002). CONCLUSIONS In the current cohort, InBT but not PoBT was associated with significantly increased risk of cancer recurrence and cancer-specific mortality. This observation requires further studies to assess the impact and management of more restrictive intraoperative blood management strategies. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1370 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Yasmin Abu-Ghanem More articles by this author Zohar Dotan More articles by this author Issac Kaver More articles by this author Dorit Zilberman More articles by this author Jacob Ramon More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Multiple Primary Synchronous Renal Cancer and Thyroid Gland Cancer at Patient with Doubling Inferior Vena Cava and Renal Veins on Both Sides (Clinical Case)

Renal cell carcinoma – the third on occurrence frequency tumor of urinogenital system and the most widespread renal tumor which makes about 2–3% of malignancies at adults. Doubling of inferior vena cava (IVC) is anomaly in case of which two inphrarenal segments of IVC are defined. Left IVC after lockin in it the left renal vein crosses an aorta in front, connects to the right renal vein and the right IVC. Combination of renal cell carcinoma and doubling IVC is rather seldom. The presented clinical case of a combination of renal cell carcinoma and doubling of IVC has the feature existence at the patient of metachronous multiple primary neoplasms that does necessary more careful inspection of the patient. Also a doubling of renal veins on both sides and a doubling of the left renal artery have been revealed. Possibilities of presurgical non-invasive diagnostics (ultrasonography and computer tomography) of retroperitoneal space vessels anomaly at the patient with transmural localization of kidney tumor allowing to plan and execute difficult surgery – an ex vivo resection of a left kidney in the conditions of pharmacological cold ischemia was shown. Performance of an ex vivo nephrectomy in the conditions of pharmacological cold ischemia allows to dilate indications to organ-preserving treatment of patients with the localized kidney cancer. However long cold ischemia and the subsequent vascular reconstruction demand dynamic observation over kidney’s functional conditions.

The Dynamics of Acute Renal Impairment Markers During a Surgery for Kidney Cancer

The purpose of the study is to investigate the effect of epidural block on the functional state of the kidneys in patients with localized cancer during kidney resection under the conditions of warm ischemia. Materials and methods. We examined 45 patients (25 men and 20 women) with a localized kidney cancer (T1N0M0) aged 56.5±8.7 years. All the patients underwent kidney resection performed under conditions of warm ischemia (15—20 minutes). Patients were divided into 2 groups: the main group (25 subjects) in which the perioperative epidural block was applied and the reference group (20 patients) without the epidural block. The following parameters were tested in blood and urine using the ELISA technique: cystatin C, L-FABP, KIM-1 , IL-18, and GFR. The test was carried out 1 hour prior to surgery, 20 minutes after the warm ischemia stage, and on Days 1 and 3. Based on the baseline cystatin С level, the patients in each group were divided into 2 subgroups: subgroup 1 —cystatin C is 1000 ng/ml and lower; subgroup 2 — more than 1000 ng/ml. The statistical processing of the findings was performed using the Statistica 6.0 software based on the t-test for two independent samples. Differences were considered to be statistically significant at P<0.05. Results . It has been demonstrated that functional parameters of kidneys were recovered to the baseline values by the 3rd day after the kidney resection under the warm ischemia due to perioperative epidural block. Impairment of the tubulointerstitium and glomerular apparatus were observed in the reference group. GFR values in the patients of the main group were within normal limits by Day 3, whereas in the patients of the GFR was lower by 38.8% as compared to the baseline (P<0.05). Conclusion. The use of the perioperative epidural block in patients with localized kidney cancer who underwent the organ resection under the warm ischemia demonstrated the nephroprotective effect, while maintaining the functional parameters of kidneys at the baseline level.

Периоперационные показатели качества жизни больных локализованным раком почки

Периоперационные показатели качества жизни больных локализованным раком почки

The activity of proapoptotic genes increases after renal ischemia/reperfusion

According to the World Health Organization, pathologies associated with ischemia/reperfusion occupy the leading position in the structure of mortality. The efficiency of localized kidney cancer surgery is limited by the damaging effects of prolonged warm ischemia and reperfusion. Ischemia/reperfusion damage to renal tissue may be related to changes in the expression profiles of pro- and antiapoptotic genes. Here, we have presented the longitudinal expression profiles of apoptosis-related genes in tissues of left and right (intact) kidneys of male rats exposed to unilateral ischemia followed by reperfusion. The profiles have been assessed at time points of 1, 3, and 48 h after the ischemic/reperfusion exposure by RT-qPCR quantification of mRNAs encoded by 13 genes, including BAX, p53, AIFM1, APAF1, CASP8, CASP3, CASP9,CASP7, MDM2, BCL2, CIAP1, XIAP, and ICAD, after normalization with respect to a reference gene ACTB. The study revealed a shift in the expression of pro- and antiapoptotic genes toward the predominance of proapoptotic processes, as was evinced by the increase in expression detected for the BAX, p53, AIFM1, APAF1, and CASP8 genes. One hour after the reperfusion, activation of mitochondrial, or intrinsic apoptosis was detected, while р53-dependent and extrinsic, i.e., receptor-driven, apoptosis joined at later time points. Changes in the level of expression of caspase 7 (CASP7)-encoding mRNA have only been detected 48 h after the restoration of blood flow. Changes have been observed in the transcription of pro- and antiapoptotic genes in tissues of both kidneys, which suggests the involvement of the contralateral kidney in systemic pathological process that develops during unilateral ischemia/reperfusion.

Management of high-risk localized kidney cancer: NYU Case of the Month, September 2017.

Management of high-risk localized kidney cancer: NYU Case of the Month, September 2017.

Perioperative Management of Localized Kidney Cancer

Perioperative Management of Localized Kidney Cancer

Postoperative 30-day Mortality Rates for Kidney Cancer Are Dependent on Hospital Surgical Volume: Results from a Norwegian Population-based Study

BackgroundTo improve cancer care in Norway, the government introduced surgical volume requirements for hospitals in 2015. To treat kidney cancer (KC) in Norway, the lower limit is 20 surgical procedures per year. ObjectivesTo compare the impact of hospital volume on outcome with regard to 30-d mortality (TDM) following KC surgery. Design, setting, and participantsWe identified all KC patients from the Cancer Registry of Norway diagnosed during 2008–2013 whose surgical treatment involved partial or radical nephrectomy. Hospitals were divided into three volume groups: low (LVH), intermediate (IVH), and high (HVH) volume. Outcome measurements and statistical analysisRelationships with outcome were analysed using multivariate logistic regression. Results and limitationsIn total, 3273 patients were identified. The TDM rate was 0.89% overall, 0.73% for localised KC, and 2.6% for metastatic KC. The mean (median, interquartile range) numbers of procedures for LVH, IVH and HVH were 5.2 /yr (3, 1.3–8.7), 27 /yr (26, 23–30) and 53 /yr (53, 48–58), with TDM rates of 2.2%, 0.83%, and 0.39%, respectively (p=0.001). In a multivariate logistic regression model, tumour stage, age, and hospital volume remained independent TDM predictors. The odds ratio for TDM was 4.98 (confidence interval 1.72–14.4) for LVH compared to HVH (p=0.003). Study limitations include a lack of data for surgical complications and other possible confounders. ConclusionsTDM is associated with age, stage, and hospital volume. The study supports the new regulation for hospital volume introduced in Norway. Patient summaryThe risk of dying within 30 d following kidney cancer surgery is low. Advanced disease and older age are risk factors for higher mortality. In this study, we also showed that more patients die within 30 d in hospitals performing fewer operations per year than in hospitals performing many operations.

Tumour suppressor gene (CDKNA2) status on chromosome 9p in resected renal tissue improves prognosis of localised kidney cancer.

BackgroundGenetic alterations on chromosome 9p, including inactivation of the tumour suppressor gene, CDKN2A, result in cellular proliferation and growth of tumours. Our aim was to use microsatellite analysis and fluorescence in situ hybridization (FISH) to characterise the architecture of this region.ResultsSeventy-five out of 77 clear cell renal cell cancers (tumour/normal pairs) were interpretable for LOH analysis on chromosome 9p (two tumours were excluded, as all five primers were uninformative). Twenty out of 75 (26.6%) tumours showed LOH in at least one of the five primers employed. Most allelic deletions were detected, telomeric to the CDKN2A region at D9S916, with 11 out of 52 informative tumours (21%) displaying LOH. The LOH in the coding region of CDKN2A, at D9S974 and D9S942, was associated with a higher pT-stage (p = 0.004) and metastasis (p = 0.006, both markers). The rate of chromosome 9p deletion in ccRCC was 44% (35/80 cases) according to FISH. Somatic copy number loss of chromosome 9p was associated with a larger tumour size (p = 0.002), higher pathological tumour stage (p = 0.021), presence of tumour necrosis (p = 0.019) and microvascular invasion (p = 0.032). The cases with copy number loss, loss of heterozygosity and copy number neutral (n = 42) were at a higher risk of cancer-specific death when compared to tumours in category D (n = 32) (Log-rank: p = 0.001). Seventeen patients with localised ccRCC developed recurrence, and fourteen of those showed either LOH or somatic copy number loss at CDKN2A (Log-rank: p = 0.005). Multivariate analysis showed that LOH or copy number loss at CDKN2A retained its independent prognostic effect, improving the predictive accuracy of stage and SSIGN score by concordance Index C from 0.823 to 0.878 (p = 0.001).Materials and MethodsCytogenetics data, microsatellite analysis and FISH were acquired for a cohort of patients undergoing resection for clinically localised renal cancer between January 2001 and December 2005. Five microsatellite markers (D9S916, D9S1814, D9S974, D9S942 and D9S171) assessed loss of heterogeneity (LOH) using DNA samples and in the same cohort FISH analysis was accomplished on tissue microarray slides. The FISH data were scored by two observers blinded to the histological data of the patients. Cytogenetic aberrations were correlated with histological and clinical outcomes by univariate and multivariate analyses using different prognostic models. Disease specific and recurrence free survival based on cytogenetic changes were assessed by Kaplan Meier methods.ConclusionsA comprehensive cytogenetic analysis using microsatellite analysis and FISH of the CDKN2A region on chromosome 9p improves the predictive accuracy of known prognostic factors in clinically localised renal cell carcinoma undergoing surgical resection.

Author Reply

When faced with a diagnosis of putatively localized kidney cancer, patients and their physicians alike want to be able to understand both their risk of recurrence and their cancer-specific survival. Many preoperative nomograms, and other risk calculators, designed to answer precisely such questions, have focused on predominantly tumor-specific factors, such as tumor size, presence of presumed malignant lymphadenopathy, and specific radiographic features such as necrosis. Postoperative risk calculators also focus on a similar set of tumor-specific factors, and surgical pathology factors, in addition to variables subject to potential ascertainment bias such as performance status, and constitutional symptoms. These long-standing tools are certainly valuable.

Abstract 1251: Significant growth suppressive effects of TOPK and MELK inhibitors in kidney cancer

Abstract Kidney cancer is the seventh most common cancer and the tenth most common cause of cancer death for men, and it is the tenth most common cause of cancer for women. The 5-year disease-specific survival has improved from about 50% in 1975-1977 to 65% in 2000-2005, although that of patients at an advanced stage still remains poor with less than 10%; 30% of patients who underwent surgery of localized kidney cancer develop distant metastasis and have limited therapeutic options such as tyrosine kinase inhibitor (TKI) and mammalian target of rapamycin (mTOR) inhibitors. In addition, the clinical effects of these drugs are limited and patients often discontinue these drugs due to severe side effects including hand-foot syndrome, liver dysfunction and interstitial pneumonia. Therefore, development of more effective therapy for kidney cancer is eagerly expected. T-lymphokine-activated killer cell-originated protein kinase (TOPK) and maternal embryonic leucine zipper kinase (MELK) are promising molecular targets that play critical roles in cancer cell proliferation and maintenance of their stemness. In this study, we investigated growth promotive effect of TOPK and MELK in kidney cancer and found a complex feedback mechanism of these two molecules. Blockade of either of these two kinases effectively caused downregulation of forkhead box protein M1 (FOXM1) activity which is known as an oncogenic transcriptional factor in various types of cancer cell. On the other hand, knockdown and overexpression of FOXM1 caused downregulation and upregulation of both TOPK and MELK mRNA levels, respectively, suggesting that FOXM1 is a critical transcriptional factor for these two molecular targets. Small molecular compound inhibitors against TOPK (OTS514) and MELK (OTS167) effectively suppressed the kidney cancer cell growth and the combination of these two compounds additively induced the very strong growth suppressive effect on kidney cancer cells. Collectively, our results suggest that both TOPK and MELK are promising molecular targets for kidney cancer treatment and that dual blockade of OTS514 and OTS167 should produce synergistic anti-tumor effects with low risk of side effects. Citation Format: Taigo Kato, Hiroyuki Inoue, Seiya Imoto, Yoshinori Tamada, Takashi Miyamoto, Yo Matsuo, Yusuke Nakamura, Jae-Hyun Park. Significant growth suppressive effects of TOPK and MELK inhibitors in kidney cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1251.

Urologic cancer in China

Cancer remains to be the second most common cause of death, and its incidence and mortality rates are increasing in China. According to the 2015 National Central Cancer Registry (NCCR) of China, the incidence of bladder cancer and prostate cancer ranked sixth and seventh, respectively, in male cancers. The majority of prostate cancer patients were diagnosed at an advanced stage. Early diagnosis of prostate cancer is the key to improve prostate cancer survival in China. Radical prostatectomy or radical radiotherapy is the main treatment for localized prostate cancer, and a comprehensive therapy based on androgen deprivation therapy is the treatment for advanced disease. The most common histologic types of bladder cancer in China were urothelial carcinoma, followed by adenocarcinoma and squamous carcinoma. The majority of patients were diagnosed using white-light cystoscopy with biopsy. Fluorescence and narrow-band imaging cystoscopy had additional detection rates and are becoming more popular. Following Chinese guidelines, most non-muscle invasive bladder cancer patients were treated with diagnostic transurethral resection and more than half of the muscle invasive bladder cancer patients were treated with radical cystectomy. Due to the increased detection rate of kidney tumors by ultrasound in physical examination, the number of incidentally diagnosed renal cell carcinoma has increased. Localized kidney cancers are more and more often treated by nephron-sparing surgery. Radical nephrectomy is still the main treatment option for patients with locally advanced renal cell carcinoma. Both laparoscopic and robotic-assisted laparoscopic surgeries have been used in big medical centers. Both testicular cancer and penile cancer have lower incidence levels than that in Europe. As we have an enormous population base, the absolute patient number is big. The diagnosis and treatment follows the Chinese guidelines. In China, both medical professionals and public should concern more on the early diagnosis, as there is not enough cancer prevention information available. Urologists should also take a more active role in educating the population.

MP34-02 PRINTED THREE-DIMENSIONAL ELASTIC ORGAN MODEL TO INCREASE ROBOT-ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY PERFORMANCE

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology III1 Apr 2016MP34-02 PRINTED THREE-DIMENSIONAL ELASTIC ORGAN MODEL TO INCREASE ROBOT-ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY PERFORMANCE Atsushi Okada, Keiichi Tozawa, Daichi Kobayashi, Kentaro Mizuno, Yukihiro Umemoto, Noriyasu Kawai, Shoichi Sasaki, Yutaro Hayashi, Katsushi Kunimoto, Kenjiro Kohri, and Takahiro Yasui Atsushi OkadaAtsushi Okada More articles by this author , Keiichi TozawaKeiichi Tozawa More articles by this author , Daichi KobayashiDaichi Kobayashi More articles by this author , Kentaro MizunoKentaro Mizuno More articles by this author , Yukihiro UmemotoYukihiro Umemoto More articles by this author , Noriyasu KawaiNoriyasu Kawai More articles by this author , Shoichi SasakiShoichi Sasaki More articles by this author , Yutaro HayashiYutaro Hayashi More articles by this author , Katsushi KunimotoKatsushi Kunimoto More articles by this author , Kenjiro KohriKenjiro Kohri More articles by this author , and Takahiro YasuiTakahiro Yasui More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1560AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robot-assisted partial nephrectomy (RALPN) for localized renal cancer has been used to obtain cancer control during nephron-sparing surgery. In this study, we developed and examined the usefulness of a printed three-dimensional (3D) elastic organ model that could be incised using the robot apparatus to simulate actual tumor incisions. METHODS The subject was a 66-year-old woman with localized right kidney cancer. With her consent, computed tomography with contrast data was output as a Digital Imaging and Communications in Medicine image and the tumor and parenchymal parts were extracted by 3D modeling constitutional software. The elastic organ model was printed by a 3D printer (Objet500 Connex3; Stratasys Ltd., Eden Prairie, MN, USA). Using this model, we performed a surgical simulation with the da Vinci® S surgical system (Intuitive Surgical, Inc., Norcross, GA, USA) 4 days prior to the operation. The resected section's tumor diameter, incision angle, depth, and margin size were measured and used to program the da Vinci® system for the actual surgical procedure. RESULTS In the RALPN simulation, the operator could cut in the 3D elastic models using da Vinci and detect the appropriate incision line distances from the hilus and the lower and upper poles. In the subsequent RALPN, the operator could easily identify the tumor location and the kidney vasculature and perform the tumor resection smoothly according to the information from the 3D elastic model. Blood loss was minimal and ischemia time was within 25 minutes. There were no complications including postoperative bleeding or urine leakage, and renal function was unchanged compared to preoperative studies. CONCLUSIONS The information provided by the 3D model simulation not only enabled improved identification of the tumor and vasculature but also allowed for rapid tumor incision using the optimal incision line to accomplish both cancer control and nephron-sparing surgery. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e471 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Atsushi Okada More articles by this author Keiichi Tozawa More articles by this author Daichi Kobayashi More articles by this author Kentaro Mizuno More articles by this author Yukihiro Umemoto More articles by this author Noriyasu Kawai More articles by this author Shoichi Sasaki More articles by this author Yutaro Hayashi More articles by this author Katsushi Kunimoto More articles by this author Kenjiro Kohri More articles by this author Takahiro Yasui More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Thérapies ciblées néo-adjuvantes dans le cancer du rein

Targeted molecules are used in the treatment of metastatic kidney cancer. Their use before surgery could reduce tumor volume, facilitate surgical resection and treat micrometastases. In this literature review, we present the main results of studies that evaluated the benefit of targeted therapies in kidney cancer. This article is based on a systematic literature search by using Pubmed database. In prospective studies, a decrease in the size of the primary tumor has been reported to be 9.6 to 28.3%. In case of metastatic kidney cancer, cytoreductive nephrectomy could be possible after targeted therapies in tumors that initially were not available for surgery. In localized kidney cancer, a reduction of tumor volume of more than 30% is obtained in 5 to 45% of cases after neoadjuvant targeted therapies. Their use is associated with the occurrence of the usual side effects of targeted therapies plus a specific risk of delayed healing and metastatic progression during the perioperative period. The study of tumors after surgery shows a lower efficiency of the production of tumor necrosis in non-clear cell carcinomas. Data from the literature are not currently in favor of neoadjuvant use of targeted therapies in the treatment of kidney cancer. Prospective studies will be required to determine their interest in the prevention of metastatic recurrence after surgery.

Local tumour ablation for localized kidney cancer: Practice patterns in Canada.

Local tumour ablation (LTA) is a recommended option for the treatment of localized kidney cancer in nonsurgical candidates. We performed a survey to describe the practice patterns of this procedure in Canada. An electronic survey was sent by email to all urologists registered to the Canadian Urological Association (CUA). Urologists were queried about general demographic information, LTA availability at their institution (and reasons for non-availability, if it was the case), as well as the type and context of LTA use. Overall, 103 individual responses were obtained (response rate of 19.5%). Of those, 58 (56.3%) had access to LTA at their institution. Urologists who had access to LTA were more likely to work at an academic institution (69 vs. 16%, p<0.001). Among individuals who did not use LTA, the main reasons were lack of staff, such as radiologists, who can assist and/or perform the procedure (64%); and lack of expertise with the procedure (62%). Among urologists who had access to LTA, percutaneous radiofrequency and cryoablation were the most commonly used (72% and 21%, respectively); however, urologists were rarely involved in those procedures (12%). In this national survey, we found that a significant proportion of Canadian urologists did not have access to LTA. We also found that when LTA was performed, urologists were rarely involved in the procedures. Those findings represent significant areas for improvement in the access to LTA. The conclusions of this study are limited by the low response rate.